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20030065.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS May'k ZCICVlaw-io� /Am' &x I ry\ue- I-S, MAILING ADDRESS CITY ZIP ELEPHONE (-:�kmb ODUo +ZS -1-14 34 NAME ADDRESS CITY ZIP I TELEPHONE NAME BL# k-qvir consAvvicAnn 4p, zlc ic lo us ADDRESS 1 0 10 9 ten wa n(AQ,, 2�c\�je, CITY &V�\I)ml ZIP I q 22-019 TELEPHONE -;�6t) 101,0? Z000 STATE LICENSE NUMBER P EXPI NION AT MR CH99UD BY (00 1-55S- a 2.1 -1 2'�71 3 PROPERTY TAX ACCOUNT PARCEL NO. c)ls 00 1:1 NEW P3 RESIDENTIAL PLUMBING/MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULnFAMI1.Y SIGN REPAIR 0 GRADING CYDS FENCE X ( _ FT) DEMOLISH 1:1 TANK OTHER GARAGE CARPORT I RETAtNINGWALL 13 ROCKERY FIRE SPRINKLER FIRE ALARM OWE OF USE, BUSINESS OR ACTIVITY� EXPLAIN: NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER 2 DESCRIBE WORK TO BE DONE rl hl. I LPERMIT EXPIRES USE ZONE PERMIT NUMBER JOB SUITE ADDRESS c�/2_ 9 //t PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Required Permit 1160 EXISTING - PROPOSED rup2on Required Sidewalk Required REQUIRED DEDICATION- FT Undorgrourid Wiring required METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE ku Ic m VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D I POSTED I 13YEs 13NO S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED �Xp , , , LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR z 13Y DATE PARKING RECID I PROVIDED LOT AREA PLANNING REVIEWEO REMARKS . � 7 7_7 4 77 7, CHECKED BY SPECIAL INSPECT16N AREA of REQUIRED [3 YES . ]REMARKS �EA SOURCE /I GiMING % LOT SLOPE % Ar 6 � Val( PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPUCATION: 180 DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT� AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S WhWENSATION INSURANCE AND RCW 18.27. SIGNATURE WNE ORAGENT) DATE SIGNED tt�Nff I I la-7 103 OCCUPANT GROUP / OCCUPANT LOAD PER USCIOSMINALINSPECTION REGeD 1 VALUATION $ Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing E-0 Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 1425) 771-0220 APPLICATION APPROVAL This application Is not a permit unfit signed by the Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowiedged In space provided. OFFICIALS S NA�TE �7 1 RELEASED BY DATf! ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING w A RECEIVED CITY OF EDMONDS CONSTRUCTON PERMIT APPLICATION OWNER NAMEMME OF BUSINESS Mark Zacv,,a. /Aml Sary-\%.AP_ is MAILING ADDRESS CITY ZIP -7-74 34 IfELEPHONE _F —NAME 11FCF ZIP ITELEPHONE NAME k_qVV_ consAyVic-In To c 1CBL# lo us ADDRESS .1 0 10 9 ken Wa V\ G,.. CITY ZIP TELEPHONE - I I qft�\Dmt 270, J, 1. 0 to to? Z000 STATE LICENSE NUMBE E, Xf!l TION ATE -D BY CHEQU 'Wougavik (001- V55— !3 20 —1 PF -071, 1 fwfl PROPERTY TAX ACCOUNT PARCEL NO. 4 2- 15 00 0 NEW RESIDENTIAL PLUMBING / MECH COMMERCIAL COMPUANCE OR ADDMON CHANGE OF USE REMODEL MULTIFAMILY SIGN GRADING FENCE X REPAIR CYDS ( Fri DEMOUSH TANK 0 OTHER bGARAGE 0,, RETAINING WALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM ME OF USE. BUSINESS OR ACTIVITY) EXPI—JUN: --7101WEILLING NUMBER I UMBER OF CRITICA OF STORIES UNITS AREAS NUMBER 10 1 DESCRIBE WORK TO BE DONE ;11 K-1cliet-1 YL e-if d Alew &CtohfL� 4 W��/rf� 14h �� . I , �w I - "4 - , 0 �EAJ SOURCE GLAZING % LOT SLOPE % e 15 .!:!A I PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBILIC Douium (cums. SIDEWALKS. DnmmAvs, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPIUCATION: 11110 DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAW., ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THWCITY OF EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM,THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE OFFUE TO MODIF%o OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRE" AND THAT I AM 'DIE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER:' I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEnEBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEWS qU 'NSAnON INSURANCE AND RCW 10.27. __q SIGNATURE If)WNEljOfl AGENT) DATE SIGNED 1 114 -7 / D3 -10 FPERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS pLAT NAME/SUBDIVISION NO. NO. 1113 NO. V LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESGP Approved AW PerrrA RoWked street use Penn" Aw EXISTING — PROPOSED Inspecdon Required Sideorefic Required REQUIRED DEDICATION— FT underground Mang required 13 ImETER SIZE LINE SIZE —7. Of: FIXTLIRES PRV REQUIRED I YES13 NO 13 z I REMARKS OWNERJCONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE ENGINEERING REVIE09DB'r_____ - — --- - DATE BE ACCEPTED FIRE REVIEWED By DATE tu cc Im VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND REO'D POSTED 10YES 13NO 1$ SEPA REV EW SIGN AREA HEIGHT I ALLOWED , PROPOSED ALLOWED , PR COMPLETE . EXEMPT I LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR z PARKING LOT AREA PLANNING REVIEWED BY DATE REO'D I PROVIDED REMARKS 12, T d Z CHECKED BY SPECIAL INSPECTION AREA OCCUPANT REQUIRED [3YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D $ Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical GraA16 Engr. Review Engr. Inspection Fire Review Plan Chk, Deposit Fire inspection Receipt # LandscapelnsP. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECInON .(42.5) 771-0220 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or his/her Depuly: and Fees Are paid, and receipt 13 acknovAodgod in space provided. OFFICIALS SPNATt!XE TE -RELEASED BY DATIf ATTENTION EXT I IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPE&ION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING PRESS HARD I